Intestinal rehabilitation is the science that stimulates the amazing ability of the intestine to adapt to different and unexpected medical and surgical conditions. It encompasses pharmacological, dietary, and surgical options that can return the intestine to a normal function.
When the intestine is irreversibly affected and rehabilitation is not possible, parenteral nutrition is the following step. Parenteral nutrition (PN) saves thousands of lives each year but is not tolerated by everyone. Patients with a very short length of bowel, those who develop recurrent catheter related blood stream infection (CRBSI), or those who experience multiple central vein access thromboses may be at a higher risk of developing life threatening complications from the use of long-term PN. Indications for intestinal transplantation vary in the adult and pediatric populations.
In the adult population, intestinal failure is usually the result of one of the following:
- Short Bowel Syndrome (SBS). This is a malabsorption disorder caused by the surgical removal (resection) of large sections of intestine. Most cases are acquired due to removal of diseased bowel, intestinal trauma, or loss of blood supply to the gut; although some are born with a congenital short bowel. The degree to which patients suffer the consequences of SBS depends largely on the remaining intestinal anatomy. A large jejunal resection should not disturb absorption substantially because of the ability of the remaining ileum and colon to absorb increased fluid and electrolytes, maintain bile salts, and prolong movement of food and fluid through the intestine. A large ileal resection leads to significant fat malabsorption, and if the colon also is resected, fluid and electrolyte balance can be severely impaired.
- Motility disorders may also be referred to as Chronic Intestinal Pseudo-obstruction (CIPO). The anatomy and length of the bowel may be preserved, but the function (the way the small bowel moves) is impaired. Symptoms may be similar to a bowel obstruction and can include severe abdominal pain and distension, severe bloating, nausea, vomiting and the inability to eat.
- Intra-abdominal non-metastasizing tumors are tumors that grow locally and progressively obstruct the bowel. When growth occurs close to the intestinal blood supply, tumor removal can only be possible by resecting the entire intestine and replacing it with a transplanted intestine.
A list of the most common causes for intestinal failure in the adult population is listed below:
- Ischemia
- Crohn’s Disease
- Trauma
- Motility Disorder
- Tumor
- Volvulus
In the pediatric population, intestinal failure is characterized by the following:
- Short bowel syndrome and dysmotility disorders occur in the pediatric population as they due in the adult population.
- A large number of pediatric SBS cases are caused by necrotizing entero-colitis (NEC), gastroschisis, intestinal atresia, and other congenital disorders.
A list of the most common causes for intestinal failure in the pediatric population is listed below.
- Necrotizing enterocolitis
- Gastroschisis
- Omphalocele
- Intestinal atresia
- Volvulus
- Intestinal pseudo-obstruction
- Microvillus inclusion disease
- Intractable diarrhea of infancy
- Autoimmune enteritis
- Intestinal polyposis